For most of this century, the history of infectious diseases has been a story of progress, a string of victories laboriously won over deadly enemies like smallpox and cholera and typhoid. Now, a resurgence of tuberculosis threatens to teach new generations of Americans what life was like before the miracle of antibiotics. It could raise troubling questions about quarantining persons with infectious cases who refuse to follow treatment programs.
The tragedy of this new resurgence of TB is that it didn't have to happen. By the early 1980s, the incidence of tuberculosis in this country had declined to the point that experts could dream of eradicating the scourge. But complacency led to carelessness, and public health budgets were cut at a critical time. As a result, the United States is now looking at a rapid increase in cases of tuberculosis that could escalate into a major public health crisis. Particularly troubling is the prevalence of strains of the disease that are resistant to normal treatment.
A number of factors are contributing to the rise in tuberculosis. One is the AIDS epidemic, which leaves people vulnerable to TB. Another is the crisis in health care delivery, which makes treatment difficult, even for people who are contagious. The rise in homelessness and the resulting proliferation of crowded shelters creates situations in which the disease is easily transmitted. The same is true for prisons filled beyond capacity. Inmates infect each other and then, once released, spread the disease.
Meeting in Bethesda last week, the World Congress on Tuberculosis got grim assessments of the situation. In 1953, there were 84,304 cases of tuberculosis in this country. The tide turned in the mid-1980s and, last year, more than 26,000 TB cases were reported in the United States. New York City now has rates of drug-resistant tuberculosis comparable to those in the Third World.
There was a time when medical schools routinely admitted extra students because they expected some would contract tuberculosis and drop out. But valiant efforts to treat and contain the disease were so successful that in 1972 the federal government stopped giving grants to local health departments for combating tuberculosis. This could be a case study in penny wise-pound foolish decision-making. The amount of money and effort it will take to return the country to 1972 levels of TB vastly exceeds any savings the country realized from those program cuts.
Complacency carries a heavy cost. In this instance, the bill is coming due with a vengeance.